Disturbing gaps in oral health literacy

June 9, 2015

By the CDHP team

The following blog post was co-authored by Alice Horowitz and Dushanka V. Kleinman, faculty members at University of Maryland School of Public Health (SPH). Horowitz is a research associate professor in the SPH’s Department of Behaviorial and Community Health. Kleinman is a professor in the Department of Epidemiology and Biostatistics, and she is the Associate Dean for Research.

For the most part, tooth decay (dental caries) is preventable. There are concrete steps that adults can take to reduce their risk of decay and that of their children. Unfortunately, research sponsored by the University of Maryland’s School of Public Health is identifying disturbing gaps in the public’s oral health literacy.

Many participants revealed that they did not know how to brush their child’s teeth or how to teach their children to do so.

Having access to and drinking community water with optimum fluoride levels is considered one of our best weapons against this disease. Fortunately, nearly 98% of Maryland’s public water supplies are optimally fluoridated. Yet this disease is prevalent especially among low-income young children. Previously, we conducted a statewide phone survey of adults—who were either pregnant or had a child 6 years of age or younger—to gain insight into what these adults know and do about tooth decay prevention. Survey results suggested there is limited understanding about preventing this disease, especially among participants with low levels of education or whose children were insured by Medicaid. For example, 58% of Marylanders surveyed did not know the purpose of adding fluoride to water.

To learn more, we conducted four focus groups among low-income, English-speaking adults. Our findings reinforced the survey findings, suggesting strongly that the participants had a very limited understanding of how to prevent caries and also had misinformation. Further, reported practices about caries prevention were less than desirable.

For the most part, participants could cite the highly prevalent media recommendations, such as: “go to the dentist,” “brush your teeth” and “cut down on sweets.” However, many participants revealed that they did not know how to brush their child’s teeth or how to teach their children to do so. One woman wondered if tooth decay was caused by some types of baby bottle nipples. They also were confused about their children’s consumption of fruit juice. While they had heard from the WIC program to cut down on juice, they interpreted this information as meaning they could add water to the juice to protect their child’s teeth from decay. In addition, participants were unaware of the fact that decay-causing bacteria are transferred from caregiver to infant, and none had heard of the early signs of tooth decay (“white spot” lesions).

Most importantly, the majority of participants were completely unaware of the value of community water fluoridation and other fluorides to prevent tooth decay. Some parents purchased fluoride-free toothpaste because they believe fluoride to be poisonous. In addition, most participants reported they drink bottled water, not tap water. (Most brands of bottled water lack the optimal fluoride concentration.) Further, they do not provide tap water to their children.

These findings highlight the importance of providing these vulnerable populations with accurate and accessible information about how they can best prevent tooth decay for themselves and their children. It is crucial to ensure that all programs supporting low-income families incorporate and reinforce these messages and practices.

We are equipped with the research and knowledge of public health practices that reduce and prevent tooth decay. The task ahead is to ensure that vulnerable populations know about and use them.